Health cost avoidance system

Abstract

Complications of various diseases have ascertainable direct costs and indirect costs. A method of projecting direct and indirect cost savings which may be realized from targeted interventions for achieving desired clinical outcomes which may result in the avoidance or mitigation of the complication is provided. Further, a comprehensive patient care management program is provided whereby the targeted intervention strategy of the present invention provides a list of behavioral influencers which assist in achieving desired clinical outcomes. From the achievement of the desired clinical outcomes direct and indirect cost savings from the avoidance or mitigation of a complication provides a projected overall cost savings which may be realized for an employer sponsored health plan.

Description

FIELD OF THE INVENTION [0001] The present invention generally relates to the field of cost analysis for employer sponsored health plans, and particularly to a system for projecting direct and indirect health care cost savings which may be realized from specific mitigating interventions taken for a complication of a disease. BACKGROUND OF THE INVENTION [0002] In the field of health care escalating costs are a common concern for both the consumer and provider alike. Numerous health care service / benefit programs, i.e., managed care, group health, and the like, have attempted to stem these rising costs by utilizing cost projection analysis techniques. Traditionally, disease management companies only provide employer sponsored health plans with considerations of hard savings realized when calculating the impact of their disease management programs. Thus, the disease management programs quantify the direct costs associated with a particular medical procedure, disease, and / or course of tre...

AI Technical Summary

Benefits of technology

[0012] It is an object of the present invention to present a method of non-claims based calculation of savings which applies cost savings assumptions to the successful achievement of clinical o

Problems solved by technology

The currently employed cost projection techniques may only be providing a return on investment analysis, based on these direct costs.

Unfortunately, the direct cost return on investment analysis provides a limited view of the total costs which may be associated with managing a disease.

Beyond the direct health care costs of managing a disease are the indirect costs, such as the costs associated with absenteeism, presentism, and/or disability.

These indirect costs, which are commonl

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